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The war on cancer

In 1971 (a full 39 years ago) President Nixon declared war on cancer. Actually, he never used those terms, but others did when the new legislation came into force that set up the national cancer institute and set aside tons of cash to do cancer related research. In 2004, the estimated total amount of research dollars that went into cancer was about 14 .5 billion dollars. Although that number varies from year to year it has most likely risen since then. This number is derived from both public and private funding including that from pharmaceutical companies. That is a lot of mulah. What has the cancer community done in that time? That is the real question.

Well, it has NOT won the war on cancer. However, although there are quite a number of very negative commentaries out there, all is certainly not lost. The nay-sayers say that although other areas of killers such as heart disease have drastically gone down, cancer is only increasing year on year. They also say things like cancer is the biggest killer for those under 75 and that heart disease, accidents and strokes combined still kill less than cancer does for those between the ages of 45-64 (at least in 2004). They point to the fact that the percentage of people dying in 2004 of cancer was the same as that back in 1970 and even back in 1950. Many statements like that do seem to indicate that we are indeed losing the war on cancer.

I beg to differ and I don’t think that these numbers tell the complete story. But, I do agree with some conclusions being made about how cancer (and other actually) research is done and how it is funded in the US. Many think the system is broken and I happen to agree with them. Let’s take a look at this closer before I talk about why we may no be necessarily losing the war on cancer.

Cancer research is funded by national cancer agencies and other agencies when reproducible results are almost guaranteed. That means that grants have a good chance of succeeding if the researcher is asking something that can be reproduced or copied many times. For example, using mice to study human cancer allows for very good reproduction of the anti-cancer agent in question. The cancer agencies and the FDA who approves the drugs that come out of these studies are discouraging risks. They encourage authors of the grants to focus on very tiny parts of the puzzle where ver defined results can be reproduced and published. This HUGE push for publication drives the entire process. The leaps in faith or risky but potentially rewarding research is often not fundable. ALthough, there is some good in this; namely appropriate testing of the scientific hypothesis, etc…this is not good for cancer research if we are to rapidly produce drugs that will work well NOW.

Furthermore, the model systems we are using are insufficient. The mouse, rat and cell systems that are used are fantastic for some basic scientific questions but fairly lousy in addressing the real need: a curative agent to help humans. Millions upon millions of mice have been successfully treated of the cancer that researchers gave them in the lab. What about the cancers that we did not give humans in the real world. Have we cured or successfully treated them to the same degree. The answer is a resounding NO.

In this blog I will not address how to fix the problem as I only have a few answers and many questions. But, in short the FDA needs to be reworked, the grant agencies need to fund science that takes bigger risks and rewards people NOT who publish but who have real results with people. The pharma companies need to focus on creating better models instead of tumor shrinkage in mice which almost NEVER equal successful treatment in humans.

Let me wrap up by being a bit less pessimistic and perhaps more realistic. Yes we have spent billions and billions of dollars on cancer and no we have not been able to cure all or even most people with cancer. Yes, people are dying of cancer more often; in fact, in the US one out of every 2 men and one out of every 3 women are now dying of cancer. But, I don’t necessarily think we are losing the game and I am not even sure if its fair to say that this game is something that we need to win. Let me explain. 1) Children’s cancer (leukemias) are now being treated very well with excellent progress in the last 30 years. 2) The research that we have done over the last 30 years will not pay off immediately, statistics about efficacy (how well the drugs do) will take years to figure out and the benefits are probably ten years away still. 3) The amount of information that we have learned by delving into cancer in the last 30 years is astounding, even though most publications deal with only the tiniest piece of the puzzle. This amount of information has not yielded huge numbers of life saving blockbuster drugs yet, but they lay the foundation for other researchers to do so.

Finally, here is something controversial; are we supposed to win the war on cancer? Look at the issue of HIV. We have spent billions and billions of dollars and trying to solve ONE disease (not like cancer which is made up of more than 100 different diseases) and we are nowhere near a cure. People are reliant on drugs for the rest of their lives just to live and many others die from a single virus! So, what makes us think that just spending money and putting people on a task such as cancer, will automatically turn us into God, Buddah, Allah or whomever. Whose war are we winning? Are we supposed to live forever? Are we ever going to achieve cancer cures in a 95-year-old patient? In fact, part of understanding what cancer is…is understanding what normal is…for cancer is the result of abnormal growth of something that was normal first. Do non scientist even realize that despite knowing all or most of the human genes we still don’t understand all of the normal working of the cell. There are so many networks, pathways, and so on that we are still learning about every day. How can we win the war on cancer if we have not won the war on normal physiology?

So, I don’t mean to end this post on a negative note. I think we have come a long way. Despite some of the inherent problems we have with the system, we have made progress. Some of the progress that we have made will be seen in the near future. People who are diagnosed with cancer will live longer, either because it is caught earlier or because it is treated better.